BackgroundCancer patients often suffer from psychological distress during or after cancer treatment, but the use of psycho-oncological care among cancer patients is limited. One of the reasons might be that the way psycho-oncological care is organized, does not fit patients’ preferences. This study aimed to obtain detailed insight into cancer patients’ preferences regarding the organization of psycho-oncological care.Methods18 semi-structured interviews were conducted among cancer patients. Patients completed psycho-oncological treatment between 2015 and 2020 at the psychology department in a general hospital (...) or a center specialized in psychological cancer care in the Netherlands. The interview comprised questions related to preferences regarding the institute where to receive treatment, the psychologist who provides treatment, and the type of treatment, as well as questions related to experienced barriers and facilitators to receive psycho-oncological care. Interviews were digitally recorded and transcribed verbatim. Data were analyzed individually by two coders into key issues and themes.ResultsRegarding the institute, easy accessibility and prompt availability of psychol-oncological care were considered important. Regarding the psychologist, most participants had a strong preference to be treated by a psychologist specialized in cancer or other somatic diseases. Individual face-to-face therapy was preferred above other types of treatment. Several barriers were mentioned to receive psycho-oncological treatment, among which poor accessibility to psycho-oncological care, lack of knowledge on the possibilities for psycho-oncological treatment, and stigma. Most frequently mentioned facilitators were being assertive to ask for help, having a good relationship with the healthcare professional, and the integration of psycho-oncological support within medical cancer care.ConclusionFrom the patient’s perspective, the organization of psycho-oncological care for cancer patients should focus on easy accessibility and availability, delivered by specialized psychologists, and integration in medical cancer care. Online and group therapy are acceptable, but individual face-to-face therapy is preferred. It is warranted to increase awareness on psycho-oncological care targeting both patients and healthcare providers. (shrink)

Broad genome-wide testing is increasingly finding its way to the public through the online direct-to-consumer marketing of so-called personal genome tests. Personal genome tests estimate genetic susceptibilities to multiple diseases and other phenotypic traits simultaneously. Providers commonly make use of Terms of Service agreements rather than informed consent procedures. However, to protect consumers from the potential physical, psychological and social harms associated with personal genome testing and to promote autonomous decision-making with regard to the testing offer, we argue that current (...) practices of information provision are insufficient and that there is a place – and a need – for informed consent in personal genome testing, also when it is offered commercially. The increasing quantity, complexity and diversity of most testing offers, however, pose challenges for information provision and informed consent. Both specific and generic models for informed consent fail to meet its moral aims when applied to personal genome testing. Consumers should be enabled to know the limitations, risks and implications of personal genome testing and should be given control over the genetic information they do or do not wish to obtain. We present the outline of a new model for informed consent which can meet both the norm of providing sufficient information and the norm of providing understandable information. The model can be used for personal genome testing, but will also be applicable to other, future forms of broad genetic testing or screening in commercial and clinical settings. (shrink)

Broad genome‐wide testing is increasingly finding its way to the public through the online direct‐to‐consumer marketing of so‐called personal genome tests. Personal genome tests estimate genetic susceptibilities to multiple diseases and other phenotypic traits simultaneously. Providers commonly make use of Terms of Service agreements rather than informed consent procedures. However, to protect consumers from the potential physical, psychological and social harms associated with personal genome testing and to promote autonomous decision‐making with regard to the testing offer, we argue that current (...) practices of information provision are insufficient and that there is a place – and a need – for informed consent in personal genome testing, also when it is offered commercially. The increasing quantity, complexity and diversity of most testing offers, however, pose challenges for information provision and informed consent. Both specific and generic models for informed consent fail to meet its moral aims when applied to personal genome testing. Consumers should be enabled to know the limitations, risks and implications of personal genome testing and should be given control over the genetic information they do or do not wish to obtain. We present the outline of a new model for informed consent which can meet both the norm of providing sufficient information and the norm of providing understandable information. The model can be used for personal genome testing, but will also be applicable to other, future forms of broad genetic testing or screening in commercial and clinical settings. (shrink)

Perception of music and speech is based on similar auditory skills, and it is often suggested that those with enhanced music perception skills may perceive and learn novel words more easily. The current study tested whether music perception abilities are associated with novel word learning in an ambiguous learning scenario. Using a cross-situational word learning (CSWL) task, nonmusician adults were exposed to word-object pairings between eight novel words and visual referents. Novel words were either non-minimal pairs differing in all sounds (...) or minimal pairs differing in their initial consonant or vowel. In order to be successful in this task, learners need to be able to correctly encode the phonological details of the novel words and have sufficient auditory working memory to remember the correct word-object pairings. Using the Mistuning Perception Test (MPT) and the Melodic Discrimination Test (MDT), we measured learners’ pitch perception and auditory working memory. We predicted that those with higher MPT and MDT values would perform better in the CSWL task and in particular for novel words with high phonological overlap (i.e., minimal pairs). We found that higher musical perception skills led to higher accuracy for non-minimal pairs and minimal pairs differing in their initial consonant. Interestingly, this was not the case for vowel minimal pairs. We discuss the results in relation to theories of second language word learning such as the Second Language Perception model (L2LP). (shrink)

The introduction of novel diagnostic techniques in clinical domains such as genomics and radiology has led to a rich ethical debate on how to handle unsolicited findings that result from these innovations. Yet while unsolicited findings arise in both genomics and radiology, most of the relevant literature to date has tended to focus on only one of these domains. In this article, we synthesize and critically assess similarities and differences between “scanning the body” and “sequencing the genome” from an ethical (...) perspective. After briefly describing the novel diagnostic contexts leading to unsolicited findings, we synthesize and reflect on six core ethical issues that relate to both specialties: terminology; benefits and risks; autonomy; disclosure of unsolicited findings to children; uncertainty; and filters and routine screening. We identify ethical rationales that pertain to both fields and may contribute to more ethically sound policies. Considerations of preserving public trust and ensuring that people perceive healthcare policies as fair also support the need for a combined debate. (shrink)

Background: As genetics technology proceeds, practices of genetic testing have become more heterogeneous: many different types of tests are finding their way to the public in different settings and for a variety of purposes. This diversification is relevant to the discourse on ethical, legal and societal issues (ELSI) surrounding genetic testing, which must evolve to encompass these differences. One important development is the rise of personal genome testing on the basis of genetic profiling: the testing of multiple genetic variants simultaneously (...) for the prediction of common multifactorial diseases. Currently, an increasing number of companies are offering personal genome tests directly to consumers and are spurring ELSI-discussions, which stand in need of clarification. This paper presents a systematic approach to the ELSI-evaluation of personal genome testing for multifactorial diseases along the lines of its test characteristics.DiscussionThis paper addresses four test characteristics of personal genome testing: its being a non-targeted type of testing, its high analytical validity, low clinical validity and problematic clinical utility. These characteristics raise their own specific ELSI, for example: non-targeted genetic profiling poses serious problems for information provision and informed consent. Questions about the quantity and quality of the necessary information, as well as about moral responsibilities with regard to the provision of information are therefore becoming central themes within ELSI-discussions of personal genome testing. Further, the current low level of clinical validity of genetic profiles raises questions concerning societal risks and regulatory requirements, whereas simultaneously it causes traditional ELSI-issues of clinical genetics, such as psychological and health risks, discrimination, and stigmatization, to lose part of their relevance. Also, classic notions of clinical utility are challenged by the newer notion of 'personal utility.'SummaryConsideration of test characteristics is essential to any valuable discourse on the ELSI of personal genome testing for multifactorial diseases. Four key characteristics of the test - targeted/non-targeted testing, analytical validity, clinical validity and clinical utility - together determine the applicability and the relevance of ELSI to specific tests. The paper identifies and discusses four areas of interest for the ELSI-debate on personal genome testing: informational problems, risks, regulatory issues, and the notion of personal utility. (shrink)

Smajdor addresses the problem of inferior clinical outcomes among adults with impairments of capacity to give informed consent (AWIC). She notes that AWIC are generally excluded from clinical trials to protect them against harms and avoid exploitation and claims there is a causal link between involvement in clinical trials and favourable outcomes. She argues, given this link, that we should increase AWIC representation in clinical trials and can justifiably do so by recognising the capacity of AWIC to assent. AWIC form (...) a diverse group, with multiple aetiologies, including, for example, Down syndrome, traumatic brain injury and dementia. In some cases, the inability to consent may fluctuate so that the same person could be AWIC only at certain times. Yet despite these differences, the group has a shared unmet need. We agree with Smajdor that AWIC outcomes should be improved, but question whether simply increasing representation in clinical trials is sufficient to achieve this. We identify the following points: 1. AWIC are under-represented in clinical trials. There is evidence of widespread exclusion of AWIC in clinical trials within the UK and abroad and it is often a specific exclusion criterion.1 2. AWIC have worse clinical outcomes and a lower life expectancy. The life expectancy …. (shrink)

Syltern et al. (2022) propose a new approach to decision-making at the limit of viability: by default, intensive care will be initiated for every infant born in “the gray zone” of viability. This w...

During preparation for early abortion in Norway, an ultrasound examination is usually performed to determine gestation and viability. This article aims to provide a deeper understanding of women’s and health care personnel’s experiences with ultrasound viewing during abortion preparation in the first trimester. Qualitative in-depth interviews with women who had been prepared for early abortion and focus group interviews with HCP from gynaecological units were carried out. A hermeneutic-phenomenological analysis, inspired by van Manen, was chosen. Thirteen women who were pregnant (...) and considering abortion in their first trimester and 20 HCP, namely, 19 registered nurses and one medical doctor, were recruited from gynaecological units at six hospitals. The study was approved by the ethics committee. The essential meaning structure of ‘autonomy under pressure’ consisted of two themes that expressed the different experiences of both the women and the HCP, namely, expectations versus precautions and choice versus protection. The women and HCP expressed different attitudes before the consultation that affected their experiences of the ultrasound examination. While the women had expectations of a clarification based on their choice to either see or not see the ultrasound image, HCP seemed to be more concerned with predetermined rules that they believed would protect the women. Consequently, the basis for dialogue was not optimal, and women’s autonomy was under pressure. Health care personnel are ethically challenged during preabortion ultrasound examinations. Meeting the individual woman’s needs and respecting her autonomy during preparation for abortion requires sensitivity, involvement, and dialogue skills by health personnel. According to the woman’s desire to be informed about the possibility of viewing the image during the abortion preparations, a dialogue that is focused in this direction should arise before the examination. (shrink)

Drawing on ethical and legal frameworks in the Netherlands, the United States and France, we examine whether physicians are expected to inform patients about potentially relevant opportunities for expanded access to investigational drugs. While we found no definitive legal obligation, we argue that physicians have a moral obligation to discuss opportunities for expanded access with patients who have run out of treatment options to prevent inequality, to promote autonomy, and to achieve beneficence.

If our moral beliefs rest on a mistake, as moral error theorists claim, what should we do with them? According to Richard Joyce’s revolutionary moral fictionalism, error theorists should pretend to believe moral propositions in order to keep the benefits moral thinking has for their preference satisfaction. This, he claims, frees error theory from radical practical implications. In response, I argue that implementing fictionalism would not preserve our moral practices, but disrupt them. The change from moral belief to make-belief yields (...) an unintended second revolution: a revolution in the content of morality. I show that fictionalism necessarily relies on a similar justification of moral practices as David Gauthier’s contractarianism, and consequently has similar implications for moral content. Because fictionalists engage in moral thinking purely for its instrumental value, they should only accept moral obligations that are useful to them into their fiction. This restriction is important: the most useful moral fiction departs substantially from conventional moral views. Revolutionary moral fictionalism is therefore more radical than it is promised to be. (shrink)

Background:Since the adoption of the Universal Declaration of Human Rights by the United Nations in 1948, human rights as set out in government documents have gradually changed, with more and more power being transferred to individual.Objectives:The aim of this article is to analyze how the position of the patient in need of care is constructed in Norway’s renamed and revised Patients’ and Service Users’ Rights Act (originally Patients’ Rights Act, 1999) and published comments which accompanying this legislation from the Norwegian (...) Ministry of Health and Care Service.Research design:A constructivist design was used, and Fairclough’s critical discourse approach was adopted to analyze the text of the Patients’ and Service Users’ Rights Act and comments.Findings:The analysis identified three discourses: (a) political discourse, containing ethical discourses about priority and economy, in which patients are constructed as powerless individuals; (b) expert discourse, containing a theme about patients’ trust in the healthcare team and its knowledge, in which patients are constructed as helpless individuals lacking knowledge; and (c) patient participation and patient autonomy discourse, containing ethical discourses about decision-making, in which patients are constructed not only as individuals with needs and rights but also as “troublesome.”Conclusion:Dominant paternalistic discourses in the legal text validate the power of medicine, the healthcare system, and heath personnel over the needs, rights, participation, and autonomy of the patient. (shrink)

This paper examines the support for diversity from a moral perspective. Combining business ethics theory with a lens of critical discourse analysis, it reconstructs the debates on the ethicality of three disability inclusion practices—positive discrimination, job adaptations, and voluntary disclosure—drawn from multi-stakeholder interviews in disability-friendly organizations. Discursive resistance to disability inclusion practices, otherwise known to work, arises out of moral beliefs characteristic of an ethic of justice, whereas support is more often informed by an ethic of care. This study contributes (...) to the literature by laying bare how ethics fuel ‘resistance to’ rather than ‘support for’ diversity and inclusion. Like prior studies, it links such resistance to the myth of individual merit, noting that some re-appropriation of an ethic of justice becomes possible when legal awareness around issues of disability is raised in the context of work. In addition, it identifies an ethic of care as holding the greatest potential for fostering workplace inclusion yet cautions for two adverse side effects that may arise when promoting corporate care: the potential of paternalism and the inclination to individualise inherent to wellbeing initiatives. (shrink)

Information can be public among a group. Whether or not information is public matters, for example, for accounts of interdependent rational choice, of communication, and of joint intention. A standard analysis of public information identifies it with (some variant of) common belief. The latter notion is stipulatively defined as an infinite conjunction: for p to be commonly believed is for it to believed by all members of a group, for all members to believe that all members believe it, and so (...) forth. This analysis is often presupposed without much argument in philosophy. Theoretical entrenchment or intuitions about cases might give some traction on the question, but give little insight about why the identification holds, if it does. The strategy of this paper is to characterize a practical-normative role for information being public, and show that the only things that play that role are (variants of) common belief as stipulatively characterized. In more detail: a functional role for “taking a proposition for granted” in non-isolated decision making is characterized. I then present some minimal conditions under which such an attitude is correctly held. The key assumption links this attitude to beliefs about what is public. From minimal a priori principles, we can argue that a proposition being public among a group entails common commitment to believe among that group. Later sections explore partial converses to this result, the factivity of publicity and publicity from the perspective of outsiders to the group, and objections to the aprioricity of the result deriving from a posteriori existential presuppositions. (shrink)

Based on conversation analysis, this study investigates central practices in what is defined as a caring interview, in the context of welfare administration. Caring refers to a helpful interviewing in reformulations of questions, taking interviewees’ difficulties to answer into consideration; a caring attitude in the framing of questions, showing understanding of clients’ circumstances and professional’s enactment of expertise in assessments of clients’ disabilities and care needs. Data include a corpus of 43 recorded interviews in which officials at the Swedish Social (...) Insurance Agency interview clients who have applied for benefits. The study adds to research on interactional sensitivity, polar questions and epistemic stance in institutional interaction. The study shows how the interviewer prioritizes confirming polar questions, takes responsibilities of knowing into account and reduces the epistemic gap to the interviewee in practices of a caring interview. This makes the interviewing markedly different from standardized and bureaucratic interviewing. (shrink)

Ned Block argues that the higher-order (HO) approach to explaining consciousness is ‘defunct’ because a prominent objection (the ‘misrepresentation objection’) exposes the view as ‘incoherent’. What’s more, a response to this objection that I’ve offered elsewhere (Weisberg 2010) fails because it ‘amounts to abusing the notion of what-it’s-like-ness’ (xxx).1 In this response, I wish to plead guilty as charged. Indeed, I will continue herein to abuse Block’s notion of what-it’s-like-ness. After doing so, I will argue that the HO approach accounts (...) for the sense of what-it’s-like-ness that matters in a theory of consciousness. I will also argue that the only incoherence present in the HO theory is that generated by embracing Block’s controversial notion of what-it’s-like-ness, something no theorist of any stripe ought to do. Block is famous for (among other things) having introduced the notion of ‘phenomenal consciousness’ into contemporary philosophy of mind (Block 1995). This term is widely employed in the philosophical literature and it even appears in the empirical literature. But wide-speared usage has brought about divergent interpretations of the term. We can distinguish a ‘moderate’ and a ‘zealous’ reading of ‘phenomenal consciousness’. On the moderate reading, ‘phenomenal consciousness’ just means ‘experience’. Many people have embraced this sense of the term and use it to roughly pick out conscious experience involving sensory quality (states like conscious visual experiences or conscious pains, for example).2 On the zealous reading, however, phenomenal consciousness is held to be ‘distinct from any cognitive, intentional, or functional property’ (Block 1995: 234). That is, any explanation of phenomenal consciousness in exclusively cognitive, intentional, or functional terms will fail to capture, without remainder, what is really distinctive about phenomenal consciousness. Block, of course, is fully clear about embracing the zealous reading; indeed, his initial introduction of the notion is in those terms. The same ambiguity occurs with the much-used (and abused) idea of ‘what-it’s-like-ness’.. (shrink)

This article explores how female graduate engineers construct femininities in male-dominated organizations. By applying a dynamic relational understanding of gender it is argued that different versions of femininities are constructed through associations to sameness and difference. The graduate engineering profession is closely connected to hegemonic masculinity, not least by the strong representation of technology and a management system itself heavily connected to current hegemonic masculinity. The female engineers stand in a position which can be described as `the dilemma of difference' (...) that arises when women choose to construct themselves as more or less different from men, or more or less visible as women. They negotiate whether the meaning of gender should mean sameness or difference from men, and they negotiate how to relate to hegemonic masculinity. This inuences the different strategies they choose. (shrink)

With a specific example from Norway and inspiration from Sara Ahmed’s The Promise of Happiness, this article demonstrates how today’s educational rhetoric lacks the language and will to recognise a key pedagogical dimension in education: what happens when the normative ambitions of education and students meet. At best, teaching students life skills to mitigate their mental health issues is naive. Inspired by Ahmed, such an initiative might actually work against its purpose. At a time when educational outcomes are emphasised in (...) local and international political contexts, I argue that the task of philosophy of education should be 1) to reclaim the significance of the pedagogical dimension in education and 2) to philosophise on what negative emotions such as unhappiness require of education. (shrink)

A new genre of treatises on practical seamanship emerged in eighteenth-century Britain. Authored by a group of seamen with decades of experience on the lower deck of merchant and naval vessels, these texts represented the ship as a machine, and seamanship as a form of mechanical experiment which could only be carried out by deep-sea sailors. However, as this article finds, this group of sailor–authors had only a brief moment of authoritative legitimacy before their ideas were repackaged and promoted by (...) land-bound authors and naval officers, and the progenitors of the ‘science of seamanship’ were deemed unfit participants in its ongoing practice. This article explores this brief moment, taking seriously the ideas and influences of the maritime milieu which spawned it, and arguing that the codification and circulation of ‘useful knowledge’ in eighteenth-century Britain often hardened social hierarchies. Examining seamanship forces us to question the progressivist linear trajectory of an increasingly open scientific culture during this period, and to focus instead on a repeating pattern in which the working knowledge of labourers and artisans was appropriated and its original practitioners denigrated. (shrink)

Response-dependence theses are usually formulated in terms of a priori true biconditionals of roughly the form ‘something, x, falls under the concept ‘F’ ↔ x would elicit response R from subjects S under conditions C’. Such formulations are vulnerable to conditional fallacy problems; counterexamples threaten whenever the C-conditions’ coming to obtain might alter the object with respect to F. Crispin Wright has suggested that such problems can be avoided by placing the C-conditions in a proviso. This ensures that any changes (...) triggered by the C-conditions’ coming to obtain will be irrelevant to the truth of the biconditional. I argue that this move leaves the equations vulnerable to counterexamples of a slightly different kind : Cases where the change is triggered, not by the C-conditions’ coming to obtain, but by the response. I consider two ways to resist these counterexamples, and argue that both are insufficient. The upshot is a challenge that must be met if provisoed biconditionals are to serve their purpose. (shrink)

Response-dependence theses are usually formulated in terms of a priori true biconditionals of roughly the form 'something, x, falls under the concept 'F' ↔ x would elicit response R from subjects S under conditions C'. Such formulations are vulnerable to conditional fallacy problems; counterexamples threaten whenever the C-conditions' coming to obtain might alter the object with respect to F. Crispin Wright has suggested that such problems can be avoided by placing the C-conditions in a proviso. This ensures that any changes (...) triggered by the C-conditions' coming to obtain will be irrelevant to the truth of the biconditional. I argue that this move leaves the equations vulnerable to counterexamples of a slightly different kind: Cases where the change is triggered, not by the C-conditions' coming to obtain, but by the response. I consider two ways to resist these counterexamples, and argue that both are insufficient. The upshot is a challenge that must be met if provisoed biconditionals are to serve their purpose. (shrink)

This study examined psychopathological correlates of implicit and explicit shame and guilt in 30 clinical and 129 non-clinical youths aged 8–17 years. Shame and guilt were measured explicitly via two self-reports and a parent report, and implicitly by means of an Implicit Association Test (IAT), while a wide range of psychopathological symptoms were assessed with questionnaires completed by children, parents, and teachers. The results showed no differences of implicit and explicit shame and guilt between the clinical and non-clinical group, implying (...) that dysregulation of these self-conscious emotions is not per definition associated with psychopathology. Correlational analyses indicated that self-reported explicit shame was positively associated with a broad range of internalizing psychopathology, while self-reported explicit guilt was associated with higher levels of anxiety and to some extent lower levels of externalizing psychopathology. Correlations with parent-rated shame and guilt revealed the same pattern of results but were in general weaker. Furthermore, implicit shame and guilt did not show significant correlations with the various measures of psychopathology. It can be concluded that the link between shame and guilt and psychopathology is complex, and partly dependent on the disorder under study and context-related factors defining the maladaptive nature of these self-conscious emotions. (shrink)

This article explores how paid domestic work is framed in state policies and discourses, drawing upon theoretical discussions on gender, welfare and global care chains. Based on a case study of the political debate on the `reconciliation of personal, family and work life' in Spain, the author argues that dominant policy frames relate gender inequality to women's unpaid domestic work and care, while domestic workers are essentially the invisible `other'. Empowering and disempowering frames are discussed; domestic workers are mainly constructed (...) as a solution to the care problem and only marginally as subjects and rights-holders. The overall aim is to examine how public policies legitimize and produce social inequalities related to gender, class and nationality. (shrink)

Todas las reflexiones acerca del signo –convencionalismo-naturalismo, realismo- nominalismo, empirismo-racionalismo, concepción diádica-concepción triádica- se articulan en torno a las relaciones entre signo, pensamiento y realidad. Aunque todos coinciden en que un signo es "aliquid stat pro aliquo", esta antigua definición de carácter muy general adquiere implicaciones muy distintas según los presupuestos de cada autor y, todavía hoy, carecemos de un consenso en la definición de "signo".

The care for older and disabled people has been described as a core area of the Nordic model. The Nordic countries’ welfare model has also been described as women friendly, as women are not forced to make harder choices than men between work and family. The Swedish eldercare system has, during the last several decades, undergone significant changes. Previously, eldercare could be described as universal, meaning a publicly provided, comprehensive, high-quality service available to all citizens according to need and not (...) based on the ability to pay. In later years transformation of eldercare has been influenced by neoliberal politics, which emphasize economic efficiency and cost reduction through competition. Eldercare has become a more diverse multidimensional system, and a private market for home-based eldercare has been created. The numbers of eldercare providers have increased considerably, and new ways of organizing eldercare have been established. In January 2009, the Act on System of Choice in the Public Sector was introduced. The Act was supposed to provide an opportunity for interested municipalities and county councils to expose their publicly provided services to market competition, and to enable users to choose their providers. This article aims to illustrate how neoliberal reasoning dominated the policy process leading to adoption of the Act on System of Choice in the Public Sector. With the use of a discursive policy analysis the authors specifically explore how neoliberal logic dominated, and also how choice and equality were understood and interpreted in the policy process. They conclude that the neoliberal turn in eldercare claiming to centre on the individual choice of persons in need of care runs the risk of creating unequal care that decentres the eldercare worker and creates precarious work situations. (shrink)

The aim of this article is to investigate the concept of care in contemporary medical practice and medical ethics. Although care has been hailed throughout the centuries as a crucial ideal in medical practice and as an honourable virtue to be observed in codes of medical ethics, I argue that contemporary medicine and medical ethics suffer from the lack of a theoretically sustainable concept of care and then discuss possible reasons that may help to explain this absence. I draw on (...) the empirical studies of Carol Gilligan on care and connectedness as ontologically situated realities in human life. Based on a philosophical elaboration of her findings on the ethics of care emphasizing relationality, I try to show how the notion of ‘relational ontology’ originating from this stream of thought may be of help in developing a medical ethics that acknowledges care as a perspective to be observed in all interactions between physicians and patients. (shrink)

This paper considers the meaning and use of the English particle man. It is shown that the particle does quite different things when it appears in sentence-initial and sentence-final position; the first use involves expression of an emotional attitude as well as, on a particular intonation, intensification; this use is analyzed using a semantics for degree predicates along with a separate dimension for the expressive aspect. Further restrictions on modification with the sentence-initial particle involving monotonicity and evidence are introduced and (...) analyzed. The sentence-final use can be viewed as strengthening the action performed by the sentence. A formal semantics is given by making use of dynamic techniques and, in a sense, dynamically simulating the modification of certain speech acts. Some empirical and theoretical extensions of the analyses are proposed and some consequences discussed. (shrink)

In this paper I introduce a theoretical framework on care developed by the Norwegian nurse and philosopher Kari Martinsen, and I argue that this approach has relevance not only within nursing, but also within clinical medicine. I try to substantiate this claim by analysing some of the key concepts in this approach, and I illustrate the potential clinical relevance of this approach by applying it in relation to two care scenarios. Finally, I discuss some of the concerns that have been (...) raised in relation to the aim of highlighting care in medicine. (shrink)

This short essay argues that more attention should be paid to conventional norms in metaethics and metanormative theory.

To avoid post-neurosurgical language deficits, intraoperative mapping of the language function in the brain can be complemented with preoperative mapping with functional magnetic resonance imaging. The validity of an fMRI “language localizer” paradigm crucially depends on the choice of an optimal language task and baseline condition. This study presents a new fMRI “language localizer” in Russian using overt sentence completion, a task that comprehensively engages the language function by involving both production and comprehension at the word and sentence level. The (...) paradigm was validated in 18 neurologically healthy volunteers who participated in two scanning sessions, for estimating test–retest reliability. For the first time, two baseline conditions for the sentence completion task were compared. At the group level, the paradigm significantly activated both anterior and posterior language-related regions. Individual-level analysis showed that activation was elicited most consistently in the inferior frontal regions, followed by posterior temporal regions and the angular gyrus. Test–retest reliability of activation location, as measured by Dice coefficients, was moderate and thus comparable to previous studies. Test–retest reliability was higher in the frontal than temporo-parietal region and with the most liberal statistical thresholding compared to two more conservative thresholding methods. Lateralization indices were expectedly left-hemispheric, with greater lateralization in the frontal than temporo-parietal region, and showed moderate test-retest reliability. Finally, the pseudoword baseline elicited more extensive and more reliable activation, although the syllable baseline appears more feasible for future clinical use. Overall, the study demonstrated the validity and reliability of the sentence completion task for mapping the language function in the brain. The paradigm needs further validation in a clinical sample of neurosurgical patients. Additionally, the study contributes to general evidence on test–retest reliability of fMRI. (shrink)

Natural language contains many expressions with underspecified emotive content. This paper proposes a way to resolve such underspecification. Nonmonotonic inference over a knowledge base is used to derive an expected interpretation for emotive expressions in a particular context. This ‘normal’ meaning is then taken to influence the hearer’s expectations about probable interpretations, and, because of these probable interpretations, the decisions of the speaker about when use of underspecified emotive terms is appropriate.